WO2015104089A1 - Surgical kit and associated production method - Google Patents

Surgical kit and associated production method Download PDF

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Publication number
WO2015104089A1
WO2015104089A1 PCT/EP2014/075570 EP2014075570W WO2015104089A1 WO 2015104089 A1 WO2015104089 A1 WO 2015104089A1 EP 2014075570 W EP2014075570 W EP 2014075570W WO 2015104089 A1 WO2015104089 A1 WO 2015104089A1
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WO
WIPO (PCT)
Prior art keywords
handle
kit
patient
tool
fixing
Prior art date
Application number
PCT/EP2014/075570
Other languages
French (fr)
Inventor
Alain SPIELMANN
Original Assignee
Spielmann Alain
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Spielmann Alain filed Critical Spielmann Alain
Publication of WO2015104089A1 publication Critical patent/WO2015104089A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0231—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for eye surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30—Surgical pincettes without pivotal connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B46/00—Surgical drapes
    • A61B46/20—Surgical drapes specially adapted for patients
    • A61B46/23—Surgical drapes specially adapted for patients with means to retain or hold surgical implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B2017/0287—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with elastic retracting members connectable to a frame, e.g. hooked elastic wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30—Surgical pincettes without pivotal connections
    • A61B2017/305—Tweezer like handles with tubular extensions, inner slidable actuating members and distal tools, e.g. microsurgical instruments

Definitions

  • the present invention relates to a surgical treatment kit comprising a surgical tool, the tool comprising:
  • kit is particularly useful for surgical operations on the eyes such as strabismus surgery or retinal detachment, but it may also concern other parts of the patient's body.
  • the work of the help consists in particular to hold the strabismus hook that takes the muscle to its insertion and maintain it in the desired position. Then, the aid grasps and holds in position the residual scleral tendinous fibers after section of the muscle. Finally, the aid grasps and holds the conjunctiva in position.
  • the conjunctiva is a transparent mucous membrane that covers the oculomotor muscles, which are attached to the sclera.
  • An object of the invention is to provide a treatment kit that facilitates, at a lower cost, the practice of the surgeon during the surgical operation and improves the quality of the operation.
  • the subject of the invention is a surgical treatment kit of the aforementioned type, characterized in that the kit further comprises a fastener distinct from the manipulation member, the fixing member being intended to hook on the one hand to the handle, and on the other hand reversibly on an operating field, and to remain attached without external intervention, fixing member being separable from the handle and being adapted to be removably mounted on the handle, the fixing member comprising a self-locking pliers.
  • the surgical treatment kit may include one or more of the following features, taken in isolation or in any technically feasible combination:
  • the handle comprises a first portion connected to the manipulation member, a second portion connected to the fixing member and an intermediate hinge connecting the first part to the second part.
  • the handle comprises a flexible element, preferably elongated, deformable relative to the manipulation member.
  • the manipulation member comprises a member for holding the element of the patient's body, capable of grasping the element of the body of the patient.
  • the manipulation member comprises a hook.
  • the handling member comprises a self-locking pliers.
  • the manipulation member comprises a spacer.
  • the handle is curved.
  • the fixing member is configured to allow the introduction of a fold of the operating field and a point of the handle, and the fixing of the handle on the fold.
  • the handle is elastic.
  • the handle is a tongue, a wire, a cord or an elastic.
  • the invention also relates to a set of surgical treatment, comprising:
  • the invention also relates to a surgical tool, intended to form part of a kit as defined above, comprising:
  • a handle linked to the manipulation member the handle being adapted to be manually grasped by a user
  • the handle comprises a flexible elongated member deformable with respect to the manipulation member.
  • the invention also relates to a method for preparing a surgical procedure, comprising the following steps: - supply of a kit as defined above;
  • the fastener on a support outside the patient, preferably on an operative field.
  • the method of preparation is implemented without the tool comes into contact with the tissues of the body of the patient. Indeed, the method can be implemented before the beginning of the surgical procedure.
  • the method may comprise a step of introducing a fold of the outer support and a point of the handle into the fastener before the fixing step
  • the invention also relates to a surgical tool, in particular but not necessarily intended to form part of a kit as defined above, comprising:
  • a handle linked to the manipulation member the handle being adapted to be manually grasped by a user
  • the handle comprises a flexible elongated member, deformable relative to the manipulation member.
  • the tool according to the invention may comprise one or more of the following characteristics, taken in isolation or in any technically possible combination:
  • the handle and the manipulation member are made in one piece by being made of material, in particular a plastic material, and
  • the flexible elongated element is chosen from a flexible tongue, a wire, in particular a flexible wire, a wire wound in a helix, a cord or an elastic material such as rubber.
  • FIG. 1 is a schematic side view of a treatment kit comprising a tool comprising a handling member and a fastener separated by a handle according to a first embodiment of the invention
  • FIG. 2 is a schematic perspective view of a treatment kit comprising a support housing a patient and the tool of FIG. 1, linked on the one hand to the support and on the other hand to the patient;
  • FIG. 3 and 4 are schematic views of fastener variants according to a second and a third embodiment of the invention.
  • FIG. 5 is a diagrammatic view of a kit comprising a self-locking clip-type manipulation member, the self-locking mechanism being made on this self-locking latch pattern, and a fastener separated by a handle according to a fourth embodiment of the invention;
  • FIG. 6 is a schematic side view of a kit comprising a screw-type handling member and a fastener separated by a handle according to a fifth embodiment of the invention
  • FIGS. 7 and 8 are diagrammatic views from above of a kit comprising a handling member and a fastener separated by a handle according to a sixth and seventh embodiment of the invention, the tools being positioned on the ocular tissues of the patient;
  • FIG. 9 is a schematic top view of another necessary according to the invention comprising a removable fastening member relative to the manipulation member;
  • FIG. 10 is a schematic top view of the necessary comprising a handling member and a detachable fastener relative to the manipulation member according to an eighth embodiment of the invention, the tools being positioned on the skin tissues subcutaneous or deep of the patient.
  • FIGS. 1 and 2 A first set of treatment according to the invention is illustrated by FIGS. 1 and 2.
  • This set comprises a first surgical set 2 according to the invention illustrated in FIG. 1, and a support 4 outside the patient 6.
  • the support 4 comprises for example an operating table for receiving the patient 6 in support.
  • the support 4 further comprises an operating field 10 intended to cover the patient 6 by being applied to a body surface of the patient 6.
  • the surgical field 10 defines an intervention window 12 through which a body surface of the patient 6 is accessible.
  • the necessary is constituted by a tool 8 in one piece intended in particular to grasp and hold a human tissue or animal in position.
  • the tool 8 is capable of grasping ocular tissue, for example residual scleral tendinous fibers.
  • the tool 8 is intended to hang on the one hand, the body of the patient 6 and on the other hand, the support 4 and in particular the operative field 10 present on the patient 6.
  • the tool 8 comprises a manipulation member 14, enabling the tissue of the patient 6 to be operated, and a fixing member 16, to immobilize an end of the tool 8 on the operating field 10.
  • the tool 8 further comprises a rigid handle 18, adapted to be gripped by the practitioner, the handle 18 connecting the manipulation member 14 and the fixing member 16.
  • the manipulation member 14, the fixing member 16 and the handle 18 are movable jointly by the practitioner, when he grasps the handle 18 manually.
  • the manipulation member 14 comprises at its end a patient tissue holding member 20 and an intermediate portion 22 connecting the holding member 20 to the handle 18.
  • the holding member 20 is the part of the instrument adapted to grip tissue of the patient 6.
  • the holding member 20 extends the intermediate portion 22 in an axial direction relative to the local axis of the handle 18 at its end. .
  • the holding member 20 is preferably atraumatic.
  • atraumatic is meant in particular that it is neither sharp nor piercing nor blunt. It is therefore not likely to hurt the tissue handled.
  • the holding member 20 is made of a re-sterilizable material capable of coming into contact with human or animal tissue, such as stainless steel, or disposable sterilizable materials, such as certain plastics or metals.
  • sterilizable means in particular that it can undergo a sterilization process, namely a technique for removing any microbial germ.
  • resterilizable is meant in particular that it can undergo several sterilization processes.
  • the holding element 20 is here in one piece by being made of material.
  • it includes a hook 24 having a curved portion 26.
  • the curved portion 26 of the hook 24 is the portion of the holding member 20 for grasping the tissue of the patient 6.
  • the intermediate portion 22 connects the holding member 20 to the rest of the tool 8.
  • the ends 28 and 30 of this portion 22 are respectively connected to the holding member 20 and the handle 18.
  • the intermediate portion 22 is straight. It is here coaxial with the handle 18.
  • the fastener 16 is a crocodile clip.
  • It comprises holding jaws 32 on the operative field 10, arms 34, connected to the jaws 32, and a hinge means 36 connecting the arms 34 to each other.
  • the fixing member 16 further comprises a limb 38 for urging the arms
  • the urging member 38 protrudes from a first arm 34. It rests at an inner portion 40 of a second arm 34.
  • At least one of the arms 34 is connected to the handle 18 by one end 42.
  • the other arm 34 is free with respect to the handle 18.
  • the arms 34 are movable relative to one another via the hinge means 36, between a position for closing the jaws 32 and an opening position of the jaws 32.
  • the urging member 38 interposes rest between the arms 34, to keep the jaws 32 pressed against each other in the closed position.
  • the free arm 34 is adapted to be moved against the biasing force of the member 38 to pass the jaws 32 in the open position.
  • the handle 18 extends linearly along a longitudinal axis
  • the manipulation member 14 and the fixing member 16 protrude axially respectively from the opposite axial ends of the handle 18.
  • the patient 6 is placed on the support 4, in preparation for the surgical operation.
  • a sterile surgical field covers the patient 6, especially at the level of his face or the upper part of his body.
  • the practitioner must maintain a portion of the patient's body 6 with the aid of the tool 8 to carry out the operation.
  • This part of the body can be the eyeball or oculomotor muscles.
  • the oculomotor muscle is grasped by the manipulation member 14. The surgeon then positions the globe in the desired position before moving the handle 18. It then fixes one end of the fastener 16 to the operating field 10 linked to the support 4 by bringing the eyeball in the same direction.
  • the surgeon removes the tool 8. It releases first the fixation between the fixing member 16 and the fold 44 of the operating field 10, by passing the jaws 32 from their closed position to their open position. Then it releases the tissues seized by the manipulator 14.
  • the tool 8 according to the invention is therefore particularly adapted to facilitate, at a lower cost, the manipulation of the practitioner during the surgical operation.
  • the tool 8 is structurally simple since it comprises two members 14 and 16 that can be manually fixed respectively to a tissue of the patient 6 and the operating field 10.
  • the gesture of use is easy and reproducible.
  • the practitioner gains mobility and ease of handling by directing the tool itself 8. It can overcome a cumbersome external help, which reduces the cost of the intervention and facilitates the approach The quality of the operation is improved.
  • the tool 8 is small, the visibility of the practitioner is increased, especially when identifying small fabrics, for example of a less than a millimeter order.
  • the practitioner may also use several tools 8, according to different embodiments, during the same surgical procedure.
  • the fastener 16 of the tool 8 is formed by a clamp, crocodile clip type.
  • the clamp comprises jaws 46 which ensure contact between the handle 18 and the operative field 10, arms 48 connected to the jaws 46 and a holding means 50 connecting the arms 48.
  • the clamp further comprises actuating members 52 which are located at the free end of the arms 48. These members 52 connect the fixing member 16 to the remainder of the tool 8.
  • the arms 48 are movable via the members 52 between a position of closing the jaws 46, forming a rest position, and an opening position of the jaws 46.
  • the holding means 50 comprises an element 54 for elastic return when the jaws 46 are biased in their open position.
  • the fastener 16 of the tool 8 is formed by a clamp type resilient return pliers.
  • the elastic return clamp comprises jaws 56 which ensure contact between the handle 18 and the operating field 10.
  • the gripper further comprises opposed arms 58 which are connected to the jaws 56.
  • the clamp further comprises a holding means 64 connecting the arms 58. This means 64 connects the fastening member 16 to the rest of the tool 8.
  • the arms 58 are movable relative to each other between a position of closure of the jaws 56, forming a rest position, and an opening position of the jaws 56.
  • the arms 58 are adapted to be moved against the biasing force due to their curvature in the rest position, to pass the jaws 56 in the open position.
  • a fourth tool 8 according to the invention is shown in FIG. 5.
  • This tool 8 comprises a fastener 16 which is similar to the fastener 16 of FIG.
  • the holding element 20 of the tool 8 is formed by a clamp, in particular a clamp provided with a sliding lock 70.
  • the clamp comprises jaws 66 which ensure the contact between the holding member 20 and the body of the patient 6.
  • the clip further comprises arms 68 similar material that are connected to the jaws 66.
  • the clamp further comprises a sliding lock 70 attached to one of the arms 68 and a holding means 72 connecting the arms 68. This means 72 connects the holding member 20 to the end 28.
  • the arms 68 are movable relative to each other between an opening position of the jaws 66, forming a rest position, and a position for closing the jaws 66.
  • Sliding latch 70 is adapted to be moved manually to lock jaws 66 in the closed position.
  • the operation of the fourth tool 8 according to the invention differs from that of the first tool 8 in that the tissue of the patient 6 is clamped between the jaws 66 and is not hooked.
  • FIG. 6 A fifth tool 8 according to the invention is shown in FIG. 6.
  • This tool 8 comprises a fastener 16 according to the embodiment of the fastener 16 of FIG.
  • the tool further comprises a holding member 20 which is formed by a clamp type screw clamp.
  • the screw clamp comprises jaws 74 which ensure the contact between the tool 8 and the tissue of the patient 6, and similar arms 76 of material which are connected to the jaws 74.
  • the clamp further comprises a screw 78 attached to one of the arms 76, a nut 80 for biasing the arms 76 and a holding means 82 connecting the arms 76.
  • This means 82 connects the fastener 16 to the rest of the body. tool 8.
  • the arms 76 are movable relative to each other between an open position of the jaws 74, forming a rest position, and a closed position of the jaws 74.
  • the nut 80 exerts a biasing force on the arm 76 when screwed onto the screw 78.
  • the arms 76 are adapted to be moved angularly towards each other to reduce the angle they form.
  • One of the ends of each arm 76 is integral with the holding means 82.
  • the arms 76 are moved by means of the biasing force of the nut 80 to pass the jaws 74 in the closed position and / or hold them in position. this position.
  • the jaws 74 can grip the tissue of the patient 6 in the closed position.
  • the operation of the fifth tool 8 according to the invention is moreover analogous to that of the fourth tool 8.
  • FIG. 1 A sixth tool 8 according to the invention is shown in FIG.
  • the tool 8 comprises a fastener 16, a handle 18 and a holding element 20.
  • the fixing member 16 and the holding member 20 are respectively analogous to the fixing member 16 of FIG. 1 and the holding member 20 of FIG.
  • the handle 18 comprises an intermediate hinge element 84 disposed between a first section 86 of the handle 18 and a second section 88 of the handle 18.
  • the axis of the first section 86 extends the intermediate portion 22 of the manipulation 14.
  • the axis of the second section 88 extends the inner portion 40 of the fastener 16.
  • the axis of the first section 86 may be angularly offset from the axis of the second section 88.
  • a material aid 90 is present on the support 4.
  • This material aid 90 or retractor, for example a blepharostat, comprises a central body 92 and two arms 94 which each have an end 96.
  • the arms 94 are movable relative to each other between an open position of the ends 96, forming a rest position, and a closed position of the ends 96. In this closed position, the arms 94 are more close to each other only in the rest position. The arms 94 are held in the closed position under the effect of an external biasing force.
  • the tool 8 makes a junction between an open eye 98 of the patient 6 and the operating field 10. For this purpose, it overlaps without contact with the other eye 100 and the nose 102 of the patient 6, thanks to the presence of the hinge element 84.
  • the surgeon spreads the eyelids of the eye 98 by means of the material aid 90. Then, he spreads the arms 94 of the retractor. The eyelids remain separated from each other.
  • the surgeon then makes an opening of the conjunctiva at the level of the oculomotor muscle 104, so that this muscle 104 becomes accessible to the tool 8.
  • the surgeon then slides the curved portion 26 of the hook 24 under the oculomotor muscle 104 desired, here the right lateral left. Then, it fixes the fixing member 16 to the operating field 10 by means of the jaws 32.
  • the surgeon can then intervene on the muscle 104.
  • the surgeon removes the tool 8. It releases the fixation between the fixing member 16 and the operating field 10, by passing the jaws 32 of their closing position to their open position. Then, it releases the grasped muscle, removing the manipulator 14 from the region of the eyeball.
  • FIG. 1 A seventh tool 8 according to the invention is shown in FIG.
  • the seventh tool 8 differs from the sixth tool 8 by the structure of the holding element 20.
  • the holding member 20 comprises an arm 106 and a sleeve 108.
  • the arm 106 comprises a transversely curved distal end 1 10 forming a jaw and a proximal end 1 12.
  • the sleeve 108 comprises a curved distal end 14 transversely forming another jaw and a proximal end 1 16.
  • the sleeve 108 is slidable along the arm 106, between an open position and a closed position. In the closed position, the distal ends 11 and 14 are in contact with each other and the proximal ends 12 and 16 are spaced from each other. In the open position, the distal ends 11 and 14 are spaced from each other and the proximal ends 12 and 16 are brought closer to each other.
  • a material aid 90 is present on the support 4. This material aid 90 is similar in its structure and use with the help of hardware 90 of FIG. 7.
  • the tool 8 makes a junction between an eye 98 of the patient 6 and the operative field 10, without overlapping the other eye 100 and the nose 102 of the patient 6.
  • the surgeon spreads the eyelids of the eye 98 by means of the material aid 90. The eyelids remain then separated from each other. the other.
  • surgeon then makes an opening of the conjunctiva at the level of the oculomotor muscle 1 18, so that this muscle 1 18 becomes accessible to the tool 8.
  • the muscle can thus be grasped over its entire width or partially.
  • the eye 98 is here maintained in abduction.
  • the surgeon can then intervene on the muscle 1 18, then suture the portion of the muscle 1 18 not held by the holding member 20 to the sclera.
  • the holding member 20 still holds the eye 98 in abduction.
  • the surgeon removes the tool 8. It releases the fixation between the fixing member 16 and the operating field 10, by moving the jaws 32 from their closed position to their open position . Then he releases the grasped muscle, spreading the ends 1 10 and 1 14 of the holding member 20 and removing the end 1 10 of the region of the eyeball.
  • the fixing member 16 is fixed on a complementary fastening element 44 formed by a fold of the operating field 10, as shown in FIG. 2.
  • a complementary element specific jaws 32, 46, 56 of the fastener 16 for example a tab, is provided on the field 10.
  • the handle 18 can be articulated so as to match the curvature of the face and to fix the fixing member 16 at the desired place on the operative field, for example with the aid of a ball joint or any flexible material.
  • it can be flexible.
  • the fixing member 16 is fixed to the support 4 before the introduction of the handling element 14 into the body of the patient 6.
  • the treatment kit comprises a fixing member 16 separated from the remainder of the tool 8.
  • the handle 18 comprises an elongate element made of a flexible material that can be deformed manually by bending. In this example, it forms a flexible tongue permanently attached to the manipulation member 14 and adapted to be removably attached to the operating field 10 by means of the fixing member 16.
  • the flexible handle 18 and the manipulation member 14 are made in one piece and are made of a material, in particular a plastic material such as polyamide or nylon. In another variant, the handle 18 and the manipulation member 14 are made of different materials.
  • the fixing member 16 is for example formed by a clamp, in particular a KOCHER clamp or a crocodile clip.
  • the fastener 16 is advantageously formed in a material distinct from the rest of the tool 8, for example metal.
  • the fixing member 16 removably attaches at a free end of the handle 18 of the tool 8, distinct from the end of the handle 18 connected to the manipulation member 14, or in any point of the flexible handle 18 away from the manipulation member 14.
  • the fastener 16 is then able to hold the tool 8 in contact with the support 4, by connection between the handle 18 and a fold 44 of the operating field 10 which are held in contact by the fixing member 16.
  • the flexibility handle 18 allows a handling of the necessary 2 with ease. In practice, the surgeon places the manipulation member 14 in contact with the tissues of the patient 6, as previously described. He then grasps the flexible handle 18 with one hand and the fastener 16 separate from the handle 18 with another hand.
  • This embodiment of the necessary 2 according to the invention is therefore particularly simple to handle and to achieve. It is also inexpensive, since the tool 8 comprising the handle 18 and the manipulation member 14 can be manufactured in one piece in large series.
  • the flexible elongate element is a straight flexible wire, in particular a cylindrical wire, or a wire wound in a helix.
  • the manipulation device 14 comprises a spacer 124.
  • This type of tool 8 is used for example in general surgery in the case of a surgical cutaneous incision or a traumatic wound.
  • the edges 120, 122 of the wound are separated by surgical treatment kits 2 of the invention.
  • the manipulator 14 of the necessary 2 comprises a spacer 124 and the fastener 16 comprises a self-locking pliers separable from the handle 18.
  • the surgeon places the spacer 124 at the edge of the wound and pulls on the bank 120, 122 of the wound to release the field of intervention.
  • the surgeon grasps the handle 18 of the tool 8 and a fold 44 of the operative field, introduces the handle 18 and the fold 44 into the self-locking clamp of the fastener 16 and activates the self-locking pliers.
  • the manipulation member comprises a hook 128.
  • the handle 18 may consist of a tongue, a wire, a cord or an elastic.

Abstract

The invention relates to a kit comprising a surgical implement (8), comprising: a manipulation body (14) for manipulating an element of the organism of the patient (6); and a handle (18) connected to the manipulation body (14), the handle (18) being hand-held by a user. The kit also comprises a fastening body (16) different from the manipulation body (14), the fastening body (16) being intended to be attached to both the handle (18) and, in a detachable manner, to a support on the outside of the patient, especially to an operative field, and to remain attached without any external intervention.

Description

Nécessaire de traitement chirurgical et procédé de préparation associé  Surgical treatment kit and method of preparing same
La présente invention concerne un nécessaire de traitement chirurgical comprenant un outil chirurgical, l'outil comprenant :  The present invention relates to a surgical treatment kit comprising a surgical tool, the tool comprising:
- un organe de manipulation d'un élément de l'organisme du patient, et  an organ for manipulating an element of the patient's body, and
- un manche lié à l'organe de manipulation, le manche étant propre à être saisi manuellement par un utilisateur.  - A handle linked to the manipulator, the handle being adapted to be entered manually by a user.
Un tel nécessaire est notamment destiné aux opérations chirurgicales portant sur les yeux comme la chirurgie du strabisme ou celle du décollement de rétine, mais il peut également concerner d'autres parties du corps du patient.  Such a kit is particularly useful for surgical operations on the eyes such as strabismus surgery or retinal detachment, but it may also concern other parts of the patient's body.
La chirurgie des muscles oculomoteurs (strabismes, paralysies oculomotrices, nystagmus...) et certaines opérations telles que les indentations sclérales pour décollement de rétine sont réalisées jusqu'à présent par un chirurgien assisté d'un aide opératoire. Cet aide opératoire maintient le globe et les muscles en position voulue, afin que le chirurgien puisse effectuer correctement l'acte chirurgical.  Surgery of the oculomotor muscles (strabismus, oculomotor paralysis, nystagmus ...) and some operations such as scleral indentations for retinal detachment have been performed until now by a surgeon assisted by a surgical assistant. This operating aid keeps the globe and muscles in the desired position, so that the surgeon can perform the surgery correctly.
Pour cela, le travail de l'aide consiste notamment à tenir le crochet à strabisme qui prend le muscle à son insertion et à le maintenir en position voulue. Puis, l'aide saisit et maintient en position les fibres tendineuses sclérales résiduelles après section du muscle. Enfin l'aide saisit et maintient en position la conjonctive.  For this, the work of the help consists in particular to hold the strabismus hook that takes the muscle to its insertion and maintain it in the desired position. Then, the aid grasps and holds in position the residual scleral tendinous fibers after section of the muscle. Finally, the aid grasps and holds the conjunctiva in position.
La conjonctive est une membrane muqueuse transparente qui recouvre les muscles oculomoteurs, lesquels sont attachés à la sclère.  The conjunctiva is a transparent mucous membrane that covers the oculomotor muscles, which are attached to the sclera.
Divers instruments existent pour crocheter le muscle ou pour saisir les tissus, mais ils nécessitent d'être tenus par l'aide opératoire ou par le chirurgien pour que le globe oculaire soit positionné de façon stable.  Various instruments exist for hooking the muscle or grasping the tissues, but they need to be held by the operative aid or by the surgeon so that the eyeball is positioned stably.
Une telle façon de faire ne donne pas entière satisfaction. L'aide opératoire encombre nécessairement l'espace situé autour de la table d'opération, et réduit donc l'espace disponible pour le praticien autour du champ opératoire. Ceci affecte notamment la visibilité du praticien, et empêche d'autres appareillages ou praticiens d'être présents au voisinage de la table d'opération. Une autre conséquence de cet encombrement est la perte de mobilité, voire d'aisance du praticien au cours de l'opération. De plus, la nécessité de disposer d'une aide opératoire en plus du praticien augmente le coût de l'intervention.  Such a way of doing things does not give complete satisfaction. Operating aid necessarily encumbers the space around the operating table, and therefore reduces the space available to the practitioner around the operating field. This affects in particular the visibility of the practitioner, and prevents other devices or practitioners from being present in the vicinity of the operating table. Another consequence of this congestion is the loss of mobility or even ease of the practitioner during the operation. In addition, the need for operating support in addition to the practitioner increases the cost of the intervention.
Un but de l'invention est de fournir un nécessaire de traitement qui facilite, à moindre coût, la pratique du chirurgien lors de l'opération chirurgicale et qui améliore la qualité de l'opération.  An object of the invention is to provide a treatment kit that facilitates, at a lower cost, the practice of the surgeon during the surgical operation and improves the quality of the operation.
A cet effet, l'invention a pour objet un nécessaire de traitement chirurgical du type précité, caractérisé en ce que le nécessaire comprend en outre un organe de fixation distinct de l'organe de manipulation, l'organe de fixation étant destiné à s'accrocher, d'une part au manche, et d'autre part de manière réversible sur un champ opératoire, et à rester accroché sans intervention extérieure, , l'organe de fixation étant séparable du manche et étant propre à être monté de manière amovible sur le manche, l'organe de fixation comportant une pince autobloquante. For this purpose, the subject of the invention is a surgical treatment kit of the aforementioned type, characterized in that the kit further comprises a fastener distinct from the manipulation member, the fixing member being intended to hook on the one hand to the handle, and on the other hand reversibly on an operating field, and to remain attached without external intervention,, fixing member being separable from the handle and being adapted to be removably mounted on the handle, the fixing member comprising a self-locking pliers.
Le nécessaire de traitement chirurgical peut comprendre l'une ou plusieurs des caractéristiques suivantes, prise(s) isolément ou suivant toute combinaison techniquement possible :  The surgical treatment kit may include one or more of the following features, taken in isolation or in any technically feasible combination:
- le manche comprend une première partie raccordée à l'organe de manipulation, une deuxième partie raccordée à l'organe de fixation et un élément intermédiaire d'articulation reliant la première partie à la deuxième partie.  - The handle comprises a first portion connected to the manipulation member, a second portion connected to the fixing member and an intermediate hinge connecting the first part to the second part.
- le manche comporte un élément flexible, avantageusement allongé, déformable par rapport à l'organe de manipulation.  - The handle comprises a flexible element, preferably elongated, deformable relative to the manipulation member.
- l'organe de manipulation comprend un élément de maintien de l'élément de l'organisme du patient, propre à saisir l'élément de l'organisme du patient.  the manipulation member comprises a member for holding the element of the patient's body, capable of grasping the element of the body of the patient.
- l'organe de manipulation comporte un crochet.  the manipulation member comprises a hook.
- l'organe de manipulation comporte une pince autobloquante.  - The handling member comprises a self-locking pliers.
- l'organe de manipulation comporte un écarteur.  the manipulation member comprises a spacer.
- le manche est incurvé.  - The handle is curved.
- l'organe de fixation est configuré pour permettre l'introduction d'un pli du champ opératoire et d'un point du manche, puis la fixation du manche sur le pli.  - The fixing member is configured to allow the introduction of a fold of the operating field and a point of the handle, and the fixing of the handle on the fold.
- le manche est élastique.  - The handle is elastic.
- le manche est une languette, un fil, une cordelette ou un élastique.  - The handle is a tongue, a wire, a cord or an elastic.
L'invention a également pour objet un ensemble de traitement chirurgical, comprenant :  The invention also relates to a set of surgical treatment, comprising:
- un support extérieur à un patient; et  - a support outside a patient; and
- un nécessaire tel que défini plus haut.  a kit as defined above.
L'invention a également pour objet un outil chirurgical, destiné à former une partie d'un nécessaire tel que défini plus haut, comprenant :  The invention also relates to a surgical tool, intended to form part of a kit as defined above, comprising:
- un organe de manipulation d'un élément de l'organisme du patient, et  an organ for manipulating an element of the patient's body, and
- un manche lié à l'organe de manipulation, le manche étant propre à être saisi manuellement par un utilisateur,  a handle linked to the manipulation member, the handle being adapted to be manually grasped by a user,
caractérisé en ce que le manche comporte un élément allongé flexible déformable par rapport à l'organe de manipulation.  characterized in that the handle comprises a flexible elongated member deformable with respect to the manipulation member.
L'invention a également pour objet un procédé de préparation d'une intervention chirurgicale, comprenant les étapes suivantes : - fourniture d'un nécessaire tel que défini plus haut; The invention also relates to a method for preparing a surgical procedure, comprising the following steps: - supply of a kit as defined above;
- fixation de l'organe de fixation sur un support extérieur au patient, avantageusement sur un champ opératoire. Dans un mode de réalisation particulier, le procédé de préparation est mis en œuvre sans que l'outil entre en contact avec les tissus de l'organisme du patient. En effet, le procédé peut être mis en œuvre avant le début de la procédure chirurgicale.  - Fixing the fastener on a support outside the patient, preferably on an operative field. In a particular embodiment, the method of preparation is implemented without the tool comes into contact with the tissues of the body of the patient. Indeed, the method can be implemented before the beginning of the surgical procedure.
Le procédé peut comprendre une étape d'introduction d'un pli du support extérieur et d'un point du manche dans l'organe de fixation avant l'étape de fixation  The method may comprise a step of introducing a fold of the outer support and a point of the handle into the fastener before the fixing step
L'invention a aussi pour objet un outil chirurgical, notamment mais pas nécessairement destiné à former une partie d'un nécessaire tel que défini plus haut, comportant :  The invention also relates to a surgical tool, in particular but not necessarily intended to form part of a kit as defined above, comprising:
- un organe de manipulation d'un élément de l'organisme du patient, et  an organ for manipulating an element of the patient's body, and
- un manche lié à l'organe de manipulation, le manche étant propre à être saisi manuellement par un utilisateur,  a handle linked to the manipulation member, the handle being adapted to be manually grasped by a user,
caractérisé en ce que le manche comporte un élément allongé flexible, déformable par rapport à l'organe de manipulation.  characterized in that the handle comprises a flexible elongated member, deformable relative to the manipulation member.
L'outil selon l'invention peut comprendre l'une ou plusieurs des caractéristiques suivantes, prise(s) isolément ou suivant toute combinaison techniquement possible :  The tool according to the invention may comprise one or more of the following characteristics, taken in isolation or in any technically possible combination:
- le manche et l'organe de manipulation sont réalisés d'un seul tenant en étant venus de matière, notamment en un matériau plastique, et  - The handle and the manipulation member are made in one piece by being made of material, in particular a plastic material, and
- l'élément allongé flexible est choisi parmi une languette flexible, un fil, notamment flexible, un fil enroulé en hélice, une cordelette ou un matériau élastique tel que du caoutchouc.  the flexible elongated element is chosen from a flexible tongue, a wire, in particular a flexible wire, a wire wound in a helix, a cord or an elastic material such as rubber.
L'invention sera mieux comprise à la lecture de la description qui va suivre, donnée uniquement à titre d'exemple, et faite en se référant aux figures annexées, parmi lesquelles :  The invention will be better understood on reading the description which follows, given solely by way of example, and with reference to the appended figures, among which:
- la figure 1 est une vue schématique de côté d'un nécessaire de traitement comprenant un outil comportant un organe de manipulation et un organe de fixation séparés par un manche selon un premier exemple de réalisation de l'invention ;  - Figure 1 is a schematic side view of a treatment kit comprising a tool comprising a handling member and a fastener separated by a handle according to a first embodiment of the invention;
- la figure 2 est une vue schématique en perspective d'un nécessaire de traitement comprenant un support accueillant un patient et l'outil de la figure 1 , lié d'une part au support et d'autre part au patient ;  FIG. 2 is a schematic perspective view of a treatment kit comprising a support housing a patient and the tool of FIG. 1, linked on the one hand to the support and on the other hand to the patient;
- les figures 3 et 4 sont des vues schématiques de variantes d'organes de fixation selon un deuxième et un troisième exemple de réalisation de l'invention ;  - Figures 3 and 4 are schematic views of fastener variants according to a second and a third embodiment of the invention;
- la figure 5 est une vue schématique d'un nécessaire comprenant un organe de manipulation de type pince autobloquante, le mécanisme autobloquant se faisant sur ce schéma par verrou autobloquant, et un organe de fixation séparés par un manche selon un quatrième exemple de réalisation de l'invention ; FIG. 5 is a diagrammatic view of a kit comprising a self-locking clip-type manipulation member, the self-locking mechanism being made on this self-locking latch pattern, and a fastener separated by a handle according to a fourth embodiment of the invention;
- la figure 6 est une vue schématique de côté d'un nécessaire comprenant un organe de manipulation de type pince à vis et un organe de fixation séparés par un manche selon un cinquième exemple de réalisation de l'invention ;  - Figure 6 is a schematic side view of a kit comprising a screw-type handling member and a fastener separated by a handle according to a fifth embodiment of the invention;
- les figures 7 et 8 sont des vues schématiques de dessus d'un nécessaire comprenant un organe de manipulation et un organe de fixation séparés par un manche selon un sixième et un septième exemple de réalisation de l'invention, les outils étant positionnés sur les tissus oculaires du patient ;  FIGS. 7 and 8 are diagrammatic views from above of a kit comprising a handling member and a fastener separated by a handle according to a sixth and seventh embodiment of the invention, the tools being positioned on the ocular tissues of the patient;
- la figure 9 est une vue schématique de dessus d'un autre nécessaire selon l'invention comprenant un organe de fixation amovible par rapport à l'organe de manipulation ; et  - Figure 9 is a schematic top view of another necessary according to the invention comprising a removable fastening member relative to the manipulation member; and
- la figure 10 est une vue schématique du dessus de nécessaires comprenant un organe de manipulation et un organe de fixation amovible par rapport à l'organe de manipulation selon un huitième exemple de réalisation de l'invention, les outils étant positionnés sur les tissus cutanés, sous-cutanés ou profonds du patient.  - Figure 10 is a schematic top view of the necessary comprising a handling member and a detachable fastener relative to the manipulation member according to an eighth embodiment of the invention, the tools being positioned on the skin tissues subcutaneous or deep of the patient.
Un premier ensemble de traitement selon l'invention est illustré par les figures 1 et 2. Cet ensemble comporte un premier nécessaire chirurgical 2 selon l'invention illustré par la figure 1 , et un support 4 extérieur au patient 6.  A first set of treatment according to the invention is illustrated by FIGS. 1 and 2. This set comprises a first surgical set 2 according to the invention illustrated in FIG. 1, and a support 4 outside the patient 6.
Le support 4 comporte par exemple une table d'opération destinée à recevoir le patient 6 en appui. Le support 4 comporte en outre un champ opératoire 10 destiné à couvrir le patient 6 en étant appliqué sur une surface corporelle du patient 6.  The support 4 comprises for example an operating table for receiving the patient 6 in support. The support 4 further comprises an operating field 10 intended to cover the patient 6 by being applied to a body surface of the patient 6.
Le champ opératoire 10 délimite une fenêtre d'intervention 12 à travers laquelle une surface corporelle du patient 6 est accessible.  The surgical field 10 defines an intervention window 12 through which a body surface of the patient 6 is accessible.
En référence à la figure 1 , le nécessaire est constitué par un outil 8 en une pièce destiné notamment à saisir et à maintenir un tissu humain ou animal en position. En particulier, l'outil 8 est propre à saisir un tissu oculaire, par exemple les fibres tendineuses sclérales résiduelles.  Referring to Figure 1, the necessary is constituted by a tool 8 in one piece intended in particular to grasp and hold a human tissue or animal in position. In particular, the tool 8 is capable of grasping ocular tissue, for example residual scleral tendinous fibers.
L'outil 8 est destiné à s'accrocher d'une part, à l'organisme du patient 6 et d'autre part, au support 4 et notamment au champ opératoire 10 présent sur le patient 6.  The tool 8 is intended to hang on the one hand, the body of the patient 6 and on the other hand, the support 4 and in particular the operative field 10 present on the patient 6.
L'outil 8 comprend un organe de manipulation 14, permettant la saisie des tissus du patient 6 à opérer, et un organe de fixation 16, permettant d'immobiliser une extrémité de l'outil 8 sur le champ opératoire 10. L'outil 8 comporte en outre un manche 18 rigide, propre à être saisi par le praticien, le manche 18 reliant l'organe de manipulation 14 et l'organe de fixation 16. L'organe de manipulation 14, l'organe de fixation 16 et le manche 18 sont déplaçables conjointement par le praticien, lorsqu'il saisit manuellement le manche 18. The tool 8 comprises a manipulation member 14, enabling the tissue of the patient 6 to be operated, and a fixing member 16, to immobilize an end of the tool 8 on the operating field 10. The tool 8 further comprises a rigid handle 18, adapted to be gripped by the practitioner, the handle 18 connecting the manipulation member 14 and the fixing member 16. The manipulation member 14, the fixing member 16 and the handle 18 are movable jointly by the practitioner, when he grasps the handle 18 manually.
L'organe de manipulation 14 comprend à son extrémité un élément de maintien 20 d'un tissu du patient et une partie intermédiaire 22 raccordant l'élément de maintien 20 au manche 18.  The manipulation member 14 comprises at its end a patient tissue holding member 20 and an intermediate portion 22 connecting the holding member 20 to the handle 18.
L'élément de maintien 20 est la partie de l'instrument propre à saisir les tissus du patient 6. L'élément de maintien 20 prolonge la partie intermédiaire 22 dans une direction axiale par rapport à l'axe local du manche 18 à son extrémité.  The holding member 20 is the part of the instrument adapted to grip tissue of the patient 6. The holding member 20 extends the intermediate portion 22 in an axial direction relative to the local axis of the handle 18 at its end. .
L'élément de maintien 20 est de préférence atraumatique. Par « atraumatique », on entend notamment qu'il n'est ni coupant, ni perçant, ni contondant. Il n'est donc pas susceptible de blesser le tissu manipulé.  The holding member 20 is preferably atraumatic. By "atraumatic" is meant in particular that it is neither sharp nor piercing nor blunt. It is therefore not likely to hurt the tissue handled.
De préférence, l'élément de maintien 20 est constitué d'un matériau restérilisable propre à entrer en contact avec un tissu humain ou animal, tel que l'acier inoxydable, ou de matériaux stérilisables à usage unique, tels certains plastiques ou certains métaux. Par « stérilisable » on entend notamment qu'il peut subir un procédé de stérilisation, à savoir une technique destinée à éliminer tout germe microbien. Par « restérilisable » on entend notamment qu'il peut subir plusieurs procédés de stérilisation.  Preferably, the holding member 20 is made of a re-sterilizable material capable of coming into contact with human or animal tissue, such as stainless steel, or disposable sterilizable materials, such as certain plastics or metals. By "sterilizable" means in particular that it can undergo a sterilization process, namely a technique for removing any microbial germ. By "resterilizable" is meant in particular that it can undergo several sterilization processes.
L'élément de maintien 20 est ici d'un seul tenant en étant venu de matière. Dans cet exemple, il comporte un crochet 24 présentant une partie recourbée 26. La partie recourbée 26 du crochet 24 est la partie de l'élément de maintien 20 destinée à saisir le tissu du patient 6.  The holding element 20 is here in one piece by being made of material. In this example, it includes a hook 24 having a curved portion 26. The curved portion 26 of the hook 24 is the portion of the holding member 20 for grasping the tissue of the patient 6.
La partie intermédiaire 22 relie l'élément de maintien 20 au reste de l'outil 8. Les extrémités 28 et 30 de cette partie 22 sont raccordées respectivement à l'élément de maintien 20 et au manche 18.  The intermediate portion 22 connects the holding member 20 to the rest of the tool 8. The ends 28 and 30 of this portion 22 are respectively connected to the holding member 20 and the handle 18.
Dans cet exemple, la partie intermédiaire 22 est droite. Elle est ici coaxiale avec le manche 18.  In this example, the intermediate portion 22 is straight. It is here coaxial with the handle 18.
Dans cet exemple, l'organe de fixation 16 est une pince crocodile.  In this example, the fastener 16 is a crocodile clip.
Il comprend des mors 32 de maintien sur le champ opératoire 10, des bras 34, reliés aux mors 32, et un moyen 36 d'articulation reliant les bras 34 entre eux.  It comprises holding jaws 32 on the operative field 10, arms 34, connected to the jaws 32, and a hinge means 36 connecting the arms 34 to each other.
L'organe de fixation 16 comporte en outre un membre 38 de sollicitation des bras The fixing member 16 further comprises a limb 38 for urging the arms
34 interposé entre les bras 34. 34 interposed between the arms 34.
Le membre 38 de sollicitation fait saillie à partir d'un premier bras 34. Il s'appuie au niveau d'une partie interne 40 d'un deuxième bras 34.  The urging member 38 protrudes from a first arm 34. It rests at an inner portion 40 of a second arm 34.
Au moins un des bras 34 est relié au manche 18 par une extrémité 42. L'autre bras 34 est libre par rapport au manche 18. Les bras 34 sont mobiles l'un par rapport à l'autre par l'intermédiaire du moyen d'articulation 36, entre une position de fermeture des mors 32 et une position d'ouverture des mors 32. At least one of the arms 34 is connected to the handle 18 by one end 42. The other arm 34 is free with respect to the handle 18. The arms 34 are movable relative to one another via the hinge means 36, between a position for closing the jaws 32 and an opening position of the jaws 32.
Le membre 38 de sollicitation s'interpose au repos entre les bras 34, pour maintenir les mors 32 appliqués l'un contre l'autre dans la position de fermeture.  The urging member 38 interposes rest between the arms 34, to keep the jaws 32 pressed against each other in the closed position.
Le bras libre 34 est propre à être déplacé à rencontre de la force de sollicitation du membre 38 pour passer les mors 32 dans la position d'ouverture.  The free arm 34 is adapted to be moved against the biasing force of the member 38 to pass the jaws 32 in the open position.
Dans cet exemple, le manche 18 s'étend linéairement le long d'un axe longitudinal In this example, the handle 18 extends linearly along a longitudinal axis
A- A'. A-A '.
II est propre à être saisi manuellement par le chirurgien.  It is suitable for manual seizure by the surgeon.
Dans cet exemple, l'organe de manipulation 14 et l'organe de fixation 16 font saillie axialement respectivement à partir des extrémités axiales opposées du manche 18.  In this example, the manipulation member 14 and the fixing member 16 protrude axially respectively from the opposite axial ends of the handle 18.
Le fonctionnement de l'outil 8 selon l'invention va maintenant être décrit.  The operation of the tool 8 according to the invention will now be described.
Initialement, le patient 6 est placé sur le support 4, en préparation de l'opération chirurgicale. Un champ opératoire 10 stérile recouvre le patient 6, notamment au niveau de son visage ou de la partie supérieure de son corps.  Initially, the patient 6 is placed on the support 4, in preparation for the surgical operation. A sterile surgical field covers the patient 6, especially at the level of his face or the upper part of his body.
Dans certains cas, le praticien doit maintenir une partie du corps du patient 6 à l'aide de l'outil 8 pour procéder à l'opération. Cette partie du corps peut être le globe oculaire ou les muscles oculomoteurs. Après abord conjonctival et dissection des tissus périmusculaires, le muscle oculomoteur est saisi par l'organe de manipulation 14. Le chirurgien positionne alors le globe en position voulue avant de déplacer le manche 18. Il fixe ensuite une extrémité de l'organe de fixation 16 au champ opératoire 10 lié au support 4 en amenant le globe oculaire dans le même sens.  In some cases, the practitioner must maintain a portion of the patient's body 6 with the aid of the tool 8 to carry out the operation. This part of the body can be the eyeball or oculomotor muscles. After conjunctival and dissection of the perimuscular tissues, the oculomotor muscle is grasped by the manipulation member 14. The surgeon then positions the globe in the desired position before moving the handle 18. It then fixes one end of the fastener 16 to the operating field 10 linked to the support 4 by bringing the eyeball in the same direction.
À cet effet, il écarte les bras 34 pour passer les mors 32 dans la position d'ouverture. Il introduit un pli 44 du champ opératoire 10 entre les mors 32 et relâche les bras 34 pour faire passer les mors 32 dans leur position de fermeture. Les mors 32 saisissent alors le champ opératoire 10 pour solidariser une extrémité de l'outil 8 sur le champ opératoire 10.  For this purpose, it spreads the arms 34 to pass the jaws 32 in the open position. It introduces a fold 44 of the operative field 10 between the jaws 32 and releases the arms 34 to pass the jaws 32 in their closed position. The jaws 32 then grip the operative field 10 to secure one end of the tool 8 on the operating field 10.
A la fin de l'intervention, le chirurgien retire l'outil 8. Il libère d'abord la fixation entre l'organe de fixation 16 et le pli 44 du champ opératoire 10, en faisant passer les mors 32 de leur position de fermeture à leur position d'ouverture. Puis il libère les tissus saisis par l'organe de manipulation 14.  At the end of the procedure, the surgeon removes the tool 8. It releases first the fixation between the fixing member 16 and the fold 44 of the operating field 10, by passing the jaws 32 from their closed position to their open position. Then it releases the tissues seized by the manipulator 14.
L'outil 8 selon l'invention est donc particulièrement adapté pour faciliter, à moindre coût, la manipulation du praticien lors de l'opération chirurgicale. En effet, l'outil 8 est simple structurellement puisqu'il comporte deux organes 14 et 16 qu'il suffit de fixer manuellement, respectivement à un tissu du patient 6 et au champ opératoire 10. La gestuelle d'utilisation est aisée et reproductible. The tool 8 according to the invention is therefore particularly adapted to facilitate, at a lower cost, the manipulation of the practitioner during the surgical operation. Indeed, the tool 8 is structurally simple since it comprises two members 14 and 16 that can be manually fixed respectively to a tissue of the patient 6 and the operating field 10. The gesture of use is easy and reproducible.
Par ailleurs, le praticien gagne en mobilité et en aisance de manipulation en orientant de lui-même l'outil 8. Il peut s'affranchir d'une aide extérieure encombrante, ce qui diminue le coût de l'intervention et facilite l'abord chirurgical du patient 6. La qualité de l'opération s'en trouve améliorée.  In addition, the practitioner gains mobility and ease of handling by directing the tool itself 8. It can overcome a cumbersome external help, which reduces the cost of the intervention and facilitates the approach The quality of the operation is improved.
De plus, l'outil 8 étant peu volumineux, la visibilité du praticien est accrue, notamment lors du repérage de tissus de petites dimensions, par exemple d'un ordre inférieur au millimètre.  In addition, the tool 8 is small, the visibility of the practitioner is increased, especially when identifying small fabrics, for example of a less than a millimeter order.
Le praticien peut également utiliser plusieurs outils 8, selon des exemples de réalisation différents, au cours de la même intervention chirurgicale.  The practitioner may also use several tools 8, according to different embodiments, during the same surgical procedure.
Dans une variante représentée sur la figure 3, l'organe de fixation 16 de l'outil 8 est formé par une pince, de type pince crocodile.  In a variant shown in Figure 3, the fastener 16 of the tool 8 is formed by a clamp, crocodile clip type.
Dans cet exemple, la pince comporte des mors 46 qui assurent le contact entre le manche 18 et le champ opératoire 10, des bras 48 raccordés aux mors 46 et un moyen de maintien 50 reliant les bras 48.  In this example, the clamp comprises jaws 46 which ensure contact between the handle 18 and the operative field 10, arms 48 connected to the jaws 46 and a holding means 50 connecting the arms 48.
La pince comporte en outre des organes d'actionnement 52 qui sont situés à l'extrémité libre des bras 48. Ces organes 52 relient l'organe de fixation 16 au reste de l'outil 8.  The clamp further comprises actuating members 52 which are located at the free end of the arms 48. These members 52 connect the fixing member 16 to the remainder of the tool 8.
Comme précédemment, les bras 48 sont mobiles par l'intermédiaire des organes 52 entre une position de fermeture des mors 46, formant une position de repos, et une position d'ouverture des mors 46.  As previously, the arms 48 are movable via the members 52 between a position of closing the jaws 46, forming a rest position, and an opening position of the jaws 46.
De plus le moyen de maintien 50 comporte un élément 54 de rappel élastique lorsque les mors 46 sont sollicités dans leur position d'ouverture.  In addition, the holding means 50 comprises an element 54 for elastic return when the jaws 46 are biased in their open position.
Dans une variante représentée sur la figure 4, l'organe de fixation 16 de l'outil 8 est formé par une pince, de type pince à rappel élastique.  In a variant shown in Figure 4, the fastener 16 of the tool 8 is formed by a clamp type resilient return pliers.
Dans cet exemple, la pince à rappel élastique comporte des mors 56 qui assurent le contact entre le manche 18 et le champ opératoire 10.  In this example, the elastic return clamp comprises jaws 56 which ensure contact between the handle 18 and the operating field 10.
La pince comporte en outre des bras 58 opposés qui sont raccordés aux mors 56. The gripper further comprises opposed arms 58 which are connected to the jaws 56.
La pince comporte en outre un moyen de maintien 64 reliant les bras 58. Ce moyen 64 relie l'organe de fixation 16 au reste de l'outil 8. The clamp further comprises a holding means 64 connecting the arms 58. This means 64 connects the fastening member 16 to the rest of the tool 8.
Les bras 58 sont mobiles l'un par rapport à l'autre entre une position de fermeture des mors 56, formant une position de repos, et une position d'ouverture des mors 56. Les bras 58 sont propres à être déplacés à rencontre de la force de sollicitation due à leur courbure dans la position de repos, pour passer les mors 56 dans la position d'ouverture. Un quatrième outil 8 selon l'invention est représenté sur la figure 5. Cet outil 8 comporte un organe de fixation 16 qui est analogue à l'organe de fixation 16 de la figure 4. The arms 58 are movable relative to each other between a position of closure of the jaws 56, forming a rest position, and an opening position of the jaws 56. The arms 58 are adapted to be moved against the biasing force due to their curvature in the rest position, to pass the jaws 56 in the open position. A fourth tool 8 according to the invention is shown in FIG. 5. This tool 8 comprises a fastener 16 which is similar to the fastener 16 of FIG.
L'élément de maintien 20 de l'outil 8 est formé par une pince, notamment une pince munie d'un verrou coulissant 70.  The holding element 20 of the tool 8 is formed by a clamp, in particular a clamp provided with a sliding lock 70.
Dans cet exemple, la pince comporte des mors 66 qui assurent le contact entre l'élément de maintien 20 et l'organisme du patient 6. La pince comporte en outre des bras 68 similaires venus de matière qui sont raccordés aux mors 66. La pince comporte en outre un verrou coulissant 70 fixé à l'un des bras 68 et un moyen de maintien 72 reliant les bras 68. Ce moyen 72 relie l'élément de maintien 20 à l'extrémité 28.  In this example, the clamp comprises jaws 66 which ensure the contact between the holding member 20 and the body of the patient 6. The clip further comprises arms 68 similar material that are connected to the jaws 66. The clamp further comprises a sliding lock 70 attached to one of the arms 68 and a holding means 72 connecting the arms 68. This means 72 connects the holding member 20 to the end 28.
Les bras 68 sont mobiles l'un par rapport à l'autre entre une position d'ouverture des mors 66, formant une position de repos, et une position de fermeture des mors 66.  The arms 68 are movable relative to each other between an opening position of the jaws 66, forming a rest position, and a position for closing the jaws 66.
Le verrou coulissant 70 est propre à être déplacé manuellement pour bloquer les mors 66 dans la position de fermeture.  Sliding latch 70 is adapted to be moved manually to lock jaws 66 in the closed position.
Le fonctionnement du quatrième outil 8 selon l'invention diffère de celui du premier outil 8 en ce que le tissu du patient 6 est pincé entre les mors 66 et n'est pas crocheté.  The operation of the fourth tool 8 according to the invention differs from that of the first tool 8 in that the tissue of the patient 6 is clamped between the jaws 66 and is not hooked.
Un cinquième outil 8 selon l'invention est représenté sur la figure 6. Cet outil 8 comporte un organe de fixation 16 selon le mode de réalisation de l'organe de fixation 16 de la figure 1 . L'outil comporte en outre un élément de maintien 20 qui est formé par une pince de type pince à vis.  A fifth tool 8 according to the invention is shown in FIG. 6. This tool 8 comprises a fastener 16 according to the embodiment of the fastener 16 of FIG. The tool further comprises a holding member 20 which is formed by a clamp type screw clamp.
Dans cet exemple, la pince à vis comporte des mors 74 qui assurent le contact entre l'outil 8 et le tissu du patient 6, et des bras 76 similaires venus de matière qui sont raccordés aux mors 74.  In this example, the screw clamp comprises jaws 74 which ensure the contact between the tool 8 and the tissue of the patient 6, and similar arms 76 of material which are connected to the jaws 74.
La pince comporte en outre une vis 78 fixée à l'un des bras 76, un écrou 80 de sollicitation des bras 76 et un moyen de maintien 82 reliant les bras 76. Ce moyen 82 relie l'organe de fixation 16 au reste de l'outil 8.  The clamp further comprises a screw 78 attached to one of the arms 76, a nut 80 for biasing the arms 76 and a holding means 82 connecting the arms 76. This means 82 connects the fastener 16 to the rest of the body. tool 8.
Les bras 76 sont mobiles l'un par rapport à l'autre entre une position d'ouverture des mors 74, formant une position de repos, et une position de fermeture des mors 74. L'écrou 80 exerce une force de sollicitation sur les bras 76 lorsqu'il est vissé sur la vis 78.  The arms 76 are movable relative to each other between an open position of the jaws 74, forming a rest position, and a closed position of the jaws 74. The nut 80 exerts a biasing force on the arm 76 when screwed onto the screw 78.
Les bras 76 sont propres à être déplacés angulairement l'un vers l'autre pour réduire l'angle qu'ils forment. L'une des extrémités de chaque bras 76 est solidaire du moyen de maintien 82. Les bras 76 sont déplacés au moyen de la force de sollicitation de l'écrou 80 pour passer les mors 74 dans la position de fermeture et/ou les maintenir dans cette position. Ainsi, les mors 74 peuvent saisir le tissu du patient 6 dans la position de fermeture. Le fonctionnement du cinquième outil 8 selon l'invention est par ailleurs analogue à celui du quatrième outil 8. The arms 76 are adapted to be moved angularly towards each other to reduce the angle they form. One of the ends of each arm 76 is integral with the holding means 82. The arms 76 are moved by means of the biasing force of the nut 80 to pass the jaws 74 in the closed position and / or hold them in position. this position. Thus, the jaws 74 can grip the tissue of the patient 6 in the closed position. The operation of the fifth tool 8 according to the invention is moreover analogous to that of the fourth tool 8.
Un sixième outil 8 selon l'invention est représenté sur la figure 7.  A sixth tool 8 according to the invention is shown in FIG.
Comme précédemment, l'outil 8 comporte un organe de fixation 16, un manche 18 et un élément de maintien 20.  As before, the tool 8 comprises a fastener 16, a handle 18 and a holding element 20.
L'organe de fixation 16 et l'élément de maintien 20 sont analogues respectivement à l'organe de fixation 16 de la figure 1 et l'élément de maintien 20 de la figure 1 .  The fixing member 16 and the holding member 20 are respectively analogous to the fixing member 16 of FIG. 1 and the holding member 20 of FIG.
Dans cet exemple, le manche 18 comporte un élément intermédiaire d'articulation 84 disposé entre un premier tronçon 86 du manche 18 et un deuxième tronçon 88 du manche 18. L'axe du premier tronçon 86 prolonge la partie intermédiaire 22 de l'organe de manipulation 14. L'axe du deuxième tronçon 88 prolonge la partie interne 40 de l'organe de fixation 16. L'axe du premier tronçon 86 peut être décalé angulairement de l'axe du deuxième tronçon 88.  In this example, the handle 18 comprises an intermediate hinge element 84 disposed between a first section 86 of the handle 18 and a second section 88 of the handle 18. The axis of the first section 86 extends the intermediate portion 22 of the manipulation 14. The axis of the second section 88 extends the inner portion 40 of the fastener 16. The axis of the first section 86 may be angularly offset from the axis of the second section 88.
Une aide matérielle 90 est présente sur le support 4. Cette aide matérielle 90, ou écarteur, par exemple un blépharostat, comprend un corps central 92 et deux bras 94 qui comportent chacun une extrémité 96.  A material aid 90 is present on the support 4. This material aid 90, or retractor, for example a blepharostat, comprises a central body 92 and two arms 94 which each have an end 96.
Les bras 94 sont mobiles l'un par rapport à l'autre entre une position d'ouverture des extrémités 96, formant une position de repos, et une position de fermeture des extrémités 96. Dans cette position de fermeture, les bras 94 sont plus proches l'un de l'autre que dans la position de repos. Les bras 94 sont maintenus dans la position de fermeture sous l'effet d'une force de sollicitation extérieure.  The arms 94 are movable relative to each other between an open position of the ends 96, forming a rest position, and a closed position of the ends 96. In this closed position, the arms 94 are more close to each other only in the rest position. The arms 94 are held in the closed position under the effect of an external biasing force.
Dans cet exemple, l'outil 8 réalise une jonction entre un œil 98 ouvert du patient 6 et le champ opératoire 10. A cet effet, il chevauche sans contact l'autre œil 100 et le nez 102 du patient 6, grâce à la présence de l'élément d'articulation 84.  In this example, the tool 8 makes a junction between an open eye 98 of the patient 6 and the operating field 10. For this purpose, it overlaps without contact with the other eye 100 and the nose 102 of the patient 6, thanks to the presence of the hinge element 84.
Avant d'introduire l'élément de maintien 20 dans la région de l'œil 98 du patient 6, le chirurgien écarte les paupières de l'œil 98 au moyen de l'aide matérielle 90. Puis, il écarte les bras 94 de l'écarteur. Les paupières restent alors écartées l'une de l'autre.  Before introducing the holding member 20 into the region of the eye 98 of the patient 6, the surgeon spreads the eyelids of the eye 98 by means of the material aid 90. Then, he spreads the arms 94 of the retractor. The eyelids remain separated from each other.
Le chirurgien effectue ensuite une ouverture de la conjonctive au niveau du muscle oculomoteur 104, afin que ce muscle 104 devienne accessible à l'outil 8.  The surgeon then makes an opening of the conjunctiva at the level of the oculomotor muscle 104, so that this muscle 104 becomes accessible to the tool 8.
Le chirurgien glisse alors la partie recourbée 26 du crochet 24 sous le muscle oculomoteur 104 souhaité, ici le droit latéral gauche. Puis, il fixe l'organe de fixation 16 au champ opératoire 10 au moyen des mors 32.  The surgeon then slides the curved portion 26 of the hook 24 under the oculomotor muscle 104 desired, here the right lateral left. Then, it fixes the fixing member 16 to the operating field 10 by means of the jaws 32.
Le chirurgien peut alors intervenir sur le muscle 104.  The surgeon can then intervene on the muscle 104.
A la fin de l'intervention, le chirurgien retire l'outil 8. Il libère la fixation entre l'organe de fixation 16 et le champ opératoire 10, en faisant passer les mors 32 de leur position de fermeture à leur position d'ouverture. Puis, il libère le muscle saisi, en retirant l'organe de manipulation 14 de la région du globe oculaire. At the end of the procedure, the surgeon removes the tool 8. It releases the fixation between the fixing member 16 and the operating field 10, by passing the jaws 32 of their closing position to their open position. Then, it releases the grasped muscle, removing the manipulator 14 from the region of the eyeball.
Un septième outil 8 selon l'invention est représenté sur la figure 8.  A seventh tool 8 according to the invention is shown in FIG.
Le septième outil 8 diffère du sixième outil 8 par la structure de l'élément de maintien 20.  The seventh tool 8 differs from the sixth tool 8 by the structure of the holding element 20.
Dans cet exemple, l'élément de maintien 20 comprend un bras 106 et un manchon 108. Le bras 106 comprend une extrémité distale 1 10 recourbée transversalement formant un mors et une extrémité proximale 1 12. Le manchon 108 comprend une extrémité distale 1 14 recourbée transversalement formant un autre mors et une extrémité proximale 1 16.  In this example, the holding member 20 comprises an arm 106 and a sleeve 108. The arm 106 comprises a transversely curved distal end 1 10 forming a jaw and a proximal end 1 12. The sleeve 108 comprises a curved distal end 14 transversely forming another jaw and a proximal end 1 16.
Le manchon 108 peut coulisser le long du bras 106, entre une position ouverte et une position fermée. Dans la position fermée, les extrémités distales 1 10 et 1 14 sont en contact l'une avec l'autre et les extrémités proximales 1 12 et 1 16 sont éloignées l'une de l'autre. Dans la position ouverte, les extrémités distales 1 10 et 1 14 sont éloignées l'une de l'autre et les extrémités proximales 1 12 et 1 16 sont rapprochées l'une de l'autre.  The sleeve 108 is slidable along the arm 106, between an open position and a closed position. In the closed position, the distal ends 11 and 14 are in contact with each other and the proximal ends 12 and 16 are spaced from each other. In the open position, the distal ends 11 and 14 are spaced from each other and the proximal ends 12 and 16 are brought closer to each other.
Une aide matérielle 90 est présente sur le support 4. Cette aide matérielle 90 est analogue dans sa structure et son utilisation à l'aide matérielle 90 de la figure 7.  A material aid 90 is present on the support 4. This material aid 90 is similar in its structure and use with the help of hardware 90 of FIG. 7.
Dans cet exemple, l'outil 8 réalise une jonction entre un œil 98 du patient 6 et le champ opératoire 10, sans chevaucher l'autre œil 100 et le nez 102 du patient 6.  In this example, the tool 8 makes a junction between an eye 98 of the patient 6 and the operative field 10, without overlapping the other eye 100 and the nose 102 of the patient 6.
Avant d'introduire l'élément de maintien 20 dans la région de l'œil 98 du patient 6, le chirurgien écarte les paupières de l'œil 98 au moyen de l'aide matérielle 90. Les paupières restent alors écartées l'une de l'autre.  Before inserting the holding member 20 in the region of the eye 98 of the patient 6, the surgeon spreads the eyelids of the eye 98 by means of the material aid 90. The eyelids remain then separated from each other. the other.
Le chirurgien effectue ensuite une ouverture de la conjonctive au niveau du muscle oculomoteur 1 18, afin que ce muscle 1 18 devienne accessible à l'outil 8.  The surgeon then makes an opening of the conjunctiva at the level of the oculomotor muscle 1 18, so that this muscle 1 18 becomes accessible to the tool 8.
Le chirurgien glisse alors l'extrémité 1 10 de l'élément de maintien 20 autour du muscle oculomoteur 1 18 souhaité, ici le droit médial gauche. Le muscle peut ainsi être saisi sur toute sa largeur ou de façon partielle. Puis le chirurgien actionne le manchon 108 en le faisant coulisser jusqu'à ce que le muscle 1 18 soit fermement maintenu entre les mors 1 10 et 1 14. L'œil 98 est alors ici maintenu en abduction. Le chirurgien fixe ensuite l'organe de fixation 16 au champ opératoire 10 au moyen des mors 32.  The surgeon then slides the end 1 10 of the holding member 20 around the desired oculomotor muscle 1 18, here the right medial left. The muscle can thus be grasped over its entire width or partially. Then the surgeon actuates the sleeve 108 by sliding it until the muscle 1 18 is firmly held between the jaws 1 10 and 1 14. The eye 98 is here maintained in abduction. The surgeon then fixes the fixation member 16 to the operative field 10 by means of the jaws 32.
Le chirurgien peut alors intervenir sur le muscle 1 18, puis suturer la partie du muscle 1 18 non maintenue par l'élément de maintien 20 à la sclère. L'élément de maintien 20 maintient encore l'œil 98 en abduction.  The surgeon can then intervene on the muscle 1 18, then suture the portion of the muscle 1 18 not held by the holding member 20 to the sclera. The holding member 20 still holds the eye 98 in abduction.
A la fin de l'intervention, le chirurgien retire l'outil 8. Il libère la fixation entre l'organe de fixation 16 et le champ opératoire 10, en faisant passer les mors 32 de leur position de fermeture à leur position d'ouverture. Puis il libère le muscle saisi, en écartant les extrémités 1 10 et 1 14 de l'élément de maintien 20 et en retirant l'extrémité 1 10 de la région du globe oculaire. At the end of the procedure, the surgeon removes the tool 8. It releases the fixation between the fixing member 16 and the operating field 10, by moving the jaws 32 from their closed position to their open position . Then he releases the grasped muscle, spreading the ends 1 10 and 1 14 of the holding member 20 and removing the end 1 10 of the region of the eyeball.
Dans ce qui a été décrit précédemment, l'organe de fixation 16 se fixe sur un élément complémentaire de fixation 44 formé par un pli du champ opératoire 10, comme représenté sur la figure 2. Dans une variante (non représentée), un élément complémentaire spécifique des mors 32, 46, 56 de l'organe de fixation 16, par exemple une languette, est prévue sur le champ 10.  In what has been previously described, the fixing member 16 is fixed on a complementary fastening element 44 formed by a fold of the operating field 10, as shown in FIG. 2. In a variant (not shown), a complementary element specific jaws 32, 46, 56 of the fastener 16, for example a tab, is provided on the field 10.
Dans une variante (non représentée), le manche 18 peut être articulé de manière à épouser la courbure du visage et à fixer l'organe de fixation 16 à l'endroit voulu sur le champ opératoire, par exemple à l'aide d'une liaison rotule ou de tout matériel flexible. En variante, il peut être flexible.  In a variant (not shown), the handle 18 can be articulated so as to match the curvature of the face and to fix the fixing member 16 at the desired place on the operative field, for example with the aid of a ball joint or any flexible material. Alternatively, it can be flexible.
Dans une autre variante (non représentée), l'organe de fixation 16 est fixé au support 4 avant l'introduction de l'élément de manipulation 14 dans l'organisme du patient 6.  In another variant (not shown), the fixing member 16 is fixed to the support 4 before the introduction of the handling element 14 into the body of the patient 6.
Dans une autre variante représentée sur la figure 9, le nécessaire de traitement comporte un organe de fixation 16 séparé du reste de l'outil 8.  In another variant shown in FIG. 9, the treatment kit comprises a fixing member 16 separated from the remainder of the tool 8.
Le manche 18 comporte un élément allongé en un matériau flexible, déformable manuellement par flexion. Il forme dans cet exemple une languette flexible fixée de manière permanente sur l'organe de manipulation 14 et propre à être fixée de manière amovible sur le champ opératoire 10 par l'intermédiaire de l'organe de fixation 16.  The handle 18 comprises an elongate element made of a flexible material that can be deformed manually by bending. In this example, it forms a flexible tongue permanently attached to the manipulation member 14 and adapted to be removably attached to the operating field 10 by means of the fixing member 16.
Dans une variante, le manche flexible 18 et l'organe de manipulation 14 sont réalisés d'un seul tenant en étant venus de matière, notamment en matière plastique telle que le polyamide ou le nylon. Dans une autre variante, le manche 18 et l'organe de manipulation 14 sont réalisés dans des matières différentes.  In a variant, the flexible handle 18 and the manipulation member 14 are made in one piece and are made of a material, in particular a plastic material such as polyamide or nylon. In another variant, the handle 18 and the manipulation member 14 are made of different materials.
L'organe de fixation 16 est par exemple formé par une pince, notamment une pince KOCHER ou une pince crocodile. L'organe de fixation 16 est avantageusement formé dans un matériau distinct du reste de l'outil 8, par exemple en métal.  The fixing member 16 is for example formed by a clamp, in particular a KOCHER clamp or a crocodile clip. The fastener 16 is advantageously formed in a material distinct from the rest of the tool 8, for example metal.
L'organe de fixation 16 se fixe de manière amovible au niveau d'une extrémité libre du manche 18 de l'outil 8, distincte de l'extrémité du manche 18 liée à l'organe de manipulation 14, ou en n'importe quel point du manche flexible 18 à l'écart de l'organe de manipulation 14.  The fixing member 16 removably attaches at a free end of the handle 18 of the tool 8, distinct from the end of the handle 18 connected to the manipulation member 14, or in any point of the flexible handle 18 away from the manipulation member 14.
L'organe de fixation 16 est alors apte à maintenir l'outil 8 en contact du support 4, par liaison entre le manche 18 et un pli 44 du champ opératoire 10 qui sont maintenus au contact par l'organe de fixation 16. La flexibilité du manche 18 permet une manipulation du nécessaire 2 avec aisance. En pratique, le chirurgien place l'organe de manipulation 14 au contact des tissus du patient 6, comme décrit précédemment. Il saisit alors le manche flexible 18 d'une main et l'organe de fixation 16 distinct du manche 18 d'une autre main. The fastener 16 is then able to hold the tool 8 in contact with the support 4, by connection between the handle 18 and a fold 44 of the operating field 10 which are held in contact by the fixing member 16. The flexibility handle 18 allows a handling of the necessary 2 with ease. In practice, the surgeon places the manipulation member 14 in contact with the tissues of the patient 6, as previously described. He then grasps the flexible handle 18 with one hand and the fastener 16 separate from the handle 18 with another hand.
Il introduit alors un pli 44 du champ opératoire et un point du manche 18 dans l'organe de fixation 16, puis active l'organe de fixation 16 pour maintenir le manche 18 fixé sur le pli 44.  He then introduces a fold 44 of the operating field and a point of the handle 18 in the fastener 16, then activates the fastener 16 to hold the handle 18 fixed on the fold 44.
Ce mode de réalisation du nécessaire 2 selon l'invention est donc particulièrement simple à manipuler et à réaliser. Il est en outre peu coûteux, puisque l'outil 8 comportant le manche 18 et l'organe de manipulation 14 peut être fabriqué d'un seul tenant en grandes séries.  This embodiment of the necessary 2 according to the invention is therefore particularly simple to handle and to achieve. It is also inexpensive, since the tool 8 comprising the handle 18 and the manipulation member 14 can be manufactured in one piece in large series.
En variante, l'élément allongé flexible est un fil flexible droit, notamment cylindrique, ou un fil enroulé en hélice.  In a variant, the flexible elongate element is a straight flexible wire, in particular a cylindrical wire, or a wire wound in a helix.
Dans une autre variante du nécessaire 2 représentée à la figure 10, l'organe de manipulation 14 comprend un écarteur 124.  In another variant of the kit 2 shown in FIG. 10, the manipulation device 14 comprises a spacer 124.
Ce type d'outil 8 sert par exemple en chirurgie générale dans le cas d'une incision chirurgicale cutanée ou d'une plaie traumatique.  This type of tool 8 is used for example in general surgery in the case of a surgical cutaneous incision or a traumatic wound.
Les berges 120, 122 de la plaie sont écartées par des nécessaires 2 de traitement chirurgical de l'invention. L'organe de manipulation 14 des nécessaires 2 comprend un écarteur 124 et l'organe de fixation 16 comprend une pince autobloquante séparable du manche 18.  The edges 120, 122 of the wound are separated by surgical treatment kits 2 of the invention. The manipulator 14 of the necessary 2 comprises a spacer 124 and the fastener 16 comprises a self-locking pliers separable from the handle 18.
En pratique, dans un premier temps, le chirurgien place l'écarteur 124 au bord de la plaie et tire sur la berge 120, 122 de la plaie pour libérer le champ d'intervention. Une fois l'écarteur 124 en place, le chirurgien saisit le manche 18 de l'outil 8 et un pli 44 du champ opératoire, introduit le manche 18 et le pli 44 dans la pince autobloquante de l'organe de fixation 16 et active la pince autobloquante.  In practice, at first, the surgeon places the spacer 124 at the edge of the wound and pulls on the bank 120, 122 of the wound to release the field of intervention. Once the retractor 124 is in place, the surgeon grasps the handle 18 of the tool 8 and a fold 44 of the operative field, introduces the handle 18 and the fold 44 into the self-locking clamp of the fastener 16 and activates the self-locking pliers.
Le même nécessaire permet également d'écarter les tissus que l'on souhaite, par exemple une structure vasculaire profonde 126. Dans ce cas, l'organe de manipulation comprend un crochet 128.  The same necessary also makes it possible to discard the desired tissue, for example a deep vascular structure 126. In this case, the manipulation member comprises a hook 128.
Il résulte de ce qui précède que le manche 18 peut être constitué d'une languette, d'un fil, d'une cordelette ou d'un élastique.  It follows from the above that the handle 18 may consist of a tongue, a wire, a cord or an elastic.

Claims

REVENDICATIONS
1 . - Nécessaire de traitement chirurgical (2) comprenant un outil chirurgical (8), l'outil (8) comprenant : 1. - Surgical treatment kit (2) comprising a surgical tool (8), the tool (8) comprising:
- un organe de manipulation (14) d'un élément de l'organisme du patient (6) ; et - un manche (18) lié à l'organe de manipulation (14), le manche (18) étant propre à être saisi manuellement par un utilisateur, - a manipulating organ (14) of an element of the patient's body (6); and - a handle (18) linked to the handling member (14), the handle (18) being able to be grasped manually by a user,
caractérisé en ce que le nécessaire (2) comprend en outre un organe de fixation (16) distinct de l'organe de manipulation (14), l'organe de fixation (16) étant destiné à s'accrocher, d'une part au manche (18), et d'autre part de manière réversible sur un support (4) extérieur au patient (6), notamment sur un champ opératoire (10), et à rester accroché sans intervention extérieure, l'organe de fixation (16) étant séparable du manche (18) et étant propre à être monté de manière amovible sur le manche (18), l'organe de fixation (16) comportant une pince autobloquante. characterized in that the kit (2) further comprises a fixing member (16) distinct from the handling member (14), the fixing member (16) being intended to hook, on the one hand to the handle (18), and on the other hand reversibly on a support (4) external to the patient (6), in particular on an operating field (10), and to remain attached without external intervention, the fixing member (16 ) being separable from the handle (18) and being capable of being removably mounted on the handle (18), the fixing member (16) comprising a self-locking clamp.
2. - Nécessaire (2) selon la revendication 1 , caractérisé en ce que le manche (18) comprend une première partie (86) raccordée à l'organe de manipulation (14), une deuxième partie (88) raccordée à l'organe de fixation (16) et un élément intermédiaire d'articulation (84) reliant la première partie (86) à la deuxième partie (88). 2. - Kit (2) according to claim 1, characterized in that the handle (18) comprises a first part (86) connected to the manipulating member (14), a second part (88) connected to the member fixing element (16) and an intermediate articulation element (84) connecting the first part (86) to the second part (88).
3. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que le manche (18) comporte un élément flexible, avantageusement allongé, déformable par rapport à l'organe de manipulation (14). 3. - Kit (2) according to any one of the preceding claims, characterized in that the handle (18) comprises a flexible element, advantageously elongated, deformable relative to the handling member (14).
4. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que l'organe de manipulation (14) comprend un élément de maintien (20) de l'élément de l'organisme du patient (6), propre à saisir l'élément de l'organisme du patient (6). 4. - Kit (2) according to any one of the preceding claims, characterized in that the handling member (14) comprises a holding element (20) of the element of the patient's body (6), suitable for capturing the element of the patient's body (6).
5.- Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que l'organe de manipulation (14) comporte un crochet (24). 5.- Kit (2) according to any one of the preceding claims, characterized in that the handling member (14) comprises a hook (24).
6. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que l'organe de manipulation (14) comporte une pince autobloquante. 6. - Kit (2) according to any one of the preceding claims, characterized in that the handling member (14) comprises a self-locking clamp.
7. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que l'organe de manipulation (14) comporte un écarteur. 7. - Kit (2) according to any one of the preceding claims, characterized in that the handling member (14) comprises a spacer.
8. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que le manche (18) est incurvé. 8. - Kit (2) according to any one of the preceding claims, characterized in that the handle (18) is curved.
9. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que l'organe de fixation (16) est configuré pour permettre l'introduction d'un pli (44) du champ opératoire et d'un point du manche (18), puis la fixation du manche (18) sur le pli (44). 9. - Kit (2) according to any one of the preceding claims, characterized in that the fixing member (16) is configured to allow the introduction of a fold (44) of the operating field and a point of the handle (18), then fixing the handle (18) on the fold (44).
10. - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que le manche (18) est élastique. 10. - Kit (2) according to any one of the preceding claims, characterized in that the handle (18) is elastic.
1 1 . - Nécessaire (2) selon l'une quelconque des revendications précédentes, caractérisé en ce que le manche (18) est une languette, un fil, une cordelette ou un élastique. 1 1 . - Kit (2) according to any one of the preceding claims, characterized in that the handle (18) is a tongue, a wire, a cord or an elastic band.
12. - Ensemble de traitement chirurgical, comprenant : 12. - Surgical treatment set, including:
- un support (4) extérieur à un patient (6) ; et - a support (4) external to a patient (6); And
- un nécessaire (2) selon l'une quelconque des revendications précédentes, l'organe de fixation (16) étant relié au support (4). - a kit (2) according to any one of the preceding claims, the fixing member (16) being connected to the support (4).
13. - Outil chirurgical (8), destiné à former une partie d'un nécessaire (2) selon l'une quelconque des revendications 1 à 1 1 , comprenant : 13. - Surgical tool (8), intended to form part of a kit (2) according to any one of claims 1 to 1 1, comprising:
- un organe de manipulation (14) d'un élément de l'organisme du patient (6), et - a manipulating organ (14) of an element of the patient's body (6), and
- un manche (18) lié à l'organe de manipulation (14), le manche (18) étant propre à être saisi manuellement par un utilisateur, - a handle (18) linked to the handling member (14), the handle (18) being able to be grasped manually by a user,
caractérisé en ce que le manche (18) comporte un élément allongé flexible déformable par rapport à l'organe de manipulation (14). characterized in that the handle (18) comprises an elongated flexible element deformable relative to the handling member (14).
14- Procédé de préparation d'une intervention chirurgicale, comprenant les étapes suivantes : 14- Process for preparing a surgical intervention, comprising the following steps:
- fourniture d'un nécessaire (2) selon l'une quelconque des revendications 1 à 1 1 ; - supply of a kit (2) according to any one of claims 1 to 1 1;
- fixation de l'organe de fixation (16) sur un support extérieur (4) au patient (6), avantageusement sur un champ opératoire (10). - fixing the fixing member (16) on an external support (4) to the patient (6), advantageously on an operating field (10).
15.- Procédé selon la revendication 14, caractérisé en ce qu'il comprend une étape d'introduction d'un pli (44) du support extérieur (4) et d'un point du manche (18) dans l'organe de fixation (16) avant l'étape de fixation. 15.- Method according to claim 14, characterized in that it comprises a step of introducing a fold (44) of the external support (4) and a point of the handle (18) into the fixing member (16) before the fixing step.
PCT/EP2014/075570 2014-01-10 2014-11-25 Surgical kit and associated production method WO2015104089A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR1450202 2014-01-10
FR1450202 2014-01-10

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000074750A2 (en) * 1999-06-03 2000-12-14 Morales, Stephen Direct injection fluid delivery device and method
US6641575B1 (en) * 1999-01-26 2003-11-04 Neal M. Lonky Surgical vacuum instrument for retracting, extracting, and manipulating tissue
US20040186356A1 (en) * 2001-08-08 2004-09-23 O'malley Michael T. Surgical retractor and tissue stabilization device
US20070156028A1 (en) * 2005-12-29 2007-07-05 Van Lue Stephen J Magnetic surgical/oral retractor
US20100174150A1 (en) * 2006-10-10 2010-07-08 Adrian Edward Park Internal Retraction Systems and Devices
US20130061857A1 (en) * 2011-09-08 2013-03-14 David McNally Surgical retaining clamp and methods of use

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6641575B1 (en) * 1999-01-26 2003-11-04 Neal M. Lonky Surgical vacuum instrument for retracting, extracting, and manipulating tissue
WO2000074750A2 (en) * 1999-06-03 2000-12-14 Morales, Stephen Direct injection fluid delivery device and method
US20040186356A1 (en) * 2001-08-08 2004-09-23 O'malley Michael T. Surgical retractor and tissue stabilization device
US20070156028A1 (en) * 2005-12-29 2007-07-05 Van Lue Stephen J Magnetic surgical/oral retractor
US20100174150A1 (en) * 2006-10-10 2010-07-08 Adrian Edward Park Internal Retraction Systems and Devices
US20130061857A1 (en) * 2011-09-08 2013-03-14 David McNally Surgical retaining clamp and methods of use

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